Ovarian Mass

Question 1

Ovarian Mass:

Risk Factors?

Answer 1

Can benign or malignant

Risk factors:
-Nulliparity
-Family history:
  breast cancer
  colon cancer
  uterine cancer
  ovarian cancer
  BRCA gene (BRCA1 60% lifetime risk, BRCA2 40% lifetime risk)
  lynch syndrome

Question 2

Ovarian Mass:

Symptoms?

Answer 2

Symptoms:

• recurrent abdominal issues
• pelvic pain
• urinary urgency
• distention/bloating
• change in appetitie

Question 3

Ovarian Mass:

Assessment?

Answer 3

Approach:

• abdomen (Ascites has a positive predictive value of 95% for ovarian cancers)
• speculum examination
• lymphadenopathy

2) Investigations
- Pelvic USS not CT or MRI

IOTA rules used to determine malignancy likelihood:
Benign features (>1 of these and NO malignant features = benign)
-unilocular cyst
-smooth multilocular tumor <10 cm
-solid components <7 mm in diameter
-presence of acoustic shadows
-no detectable Doppler signal

Malignant features (>1 of these and NO benign features = malignant)

• irregular solid tumor
• irregular multilocular-solid mass >10 cm in diameter
• ≥4 papillary structures
• ascites
• high Doppler signal (color score 4)

IF USS suspicious OR postmenopausal
-Serum CA125 (can be raised by fibroids, endometriosis, adenomysis, pelvic infections) *any elevated test should be repeated in 4 weeks

IF <40yo
-LDH and AFP (germcell tumours)

3) Risk Malignancy Index (RMI) must be calculated
(RMI = ultrasound findings x menopause status x Ca125 U/ml)
*It is particularly useful in postmenopausal women.
Moderate = 25–200
High = >200 (sensitivity of 87% and specificity of 97% for ovarian cancer)

Question 4

Ovarian Mass:

Management?

Answer 4

Management:
1) Premenopausal
Cysts <5cm = no follow up as they will resolve within 3 menstrual cycles
Cysts 5 - 7cm = repeat USS for monitoring
Cysts >7cm = surgical managment

2) Post menopausal
Cysts <5cm = repeat USS in 3 months IF RMI is low risk

-COCP can reduce cyst recurrence

If high RMI risk or Malignant suspicions on USS = referral